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ABSTRACT Introduction: measuring the severity of traumatic injuries is crucial for predicting clinical outcomes. Whereas the Injury Severity Score (ISS) has limitations in assigning scores to injuries at the same site, the New Injury Severity Score (NISS) corrects for this problem by taking into account the three most severe injuries regardless of the region of the body. This study seeks to comprehend the clinical and epidemiological profile of trauma patients while comparing the effectiveness of scales for predicting mortality. Methods: a descriptive, observational and retrospective study using records of patients who underwent thoracotomy at the Hospital das Clínicas of the Federal University of Triângulo Mineiro between 2000 and 2019. Demographic data, mechanisms of injury, affected organs, length of stay and mortality were analyzed. Injury severity was assessed using the ISS and NISS, and statistical analyses were conducted using MedCalc and SigmaPlot. Results: 101 patients were assessed, on average 29.6 years old, 86.13% of whom were men. The average duration of hospitalization was 10.9 days and the mortality rate was 28.7%. The ROC curve analysis revealed a sensitivity of 68.97%, specificity of 80.56% and area under the curve of 0.837 for the ISS, and 58.62%, 94.44% and 0.855 for the NISS, respectively. The Youden index was 0.49 for the ISS and 0.53 for the NISS. Conclusion: the study demonstrated comparable efficacy of NISS and ISS in predicting mortality. These findings hold significance in the hospital setting. Professionals must be familiar with these scales to utilize them competently for each patient.

ABSTRACT Purpose: to consolidate a Trauma Register (TR) trough REDCap data acquisition platform and to validate, in this context, local Quality Indicators (QI) as improvement opportunities in trauma management. Methods: continuous data acquisition of all patients admitted in Irmandade da Santa Casa de Misericórdia de São Paulo adult Trauma bay and it’s validation in REDCap platform; 6 months retrospective cohort of QI impact in length of hospitalar stay, complications and mortality. Fisher, Chi-squared, Wilcoxon and Kruskal-Wallis tests were used to correlate QIs fails with the endpoints, considering p

ABSTRACT Objective: to assess the role of autopsy in the diagnosis of missed injuries (MI) and definition of trauma quality program goals. Method: Retrospective analysis of autopsy reports and patient’s charts. Injuries present in the autopsy, but not in the chart, were defined as “missed”. MI were characterized using Goldman’s criteria: Class I, if the diagnosis would have modified the management and outcome; Class II, if it would have modified the management, but not the outcome; Class III, if it would not have modified neither the management nor the outcome. We used Mann-Whitney’s U and Pearson’s chi square for statistical analysis, considering p

ABSTRACT Objective: the study aims to analyze the performance and outcome of resuscitation thoracotomy (TR) performed in patients victims of penetrating and blunt trauma in a trauma center in southern Brazil during a 7 years period. Methods: retrospective study based on the analysis of medical records of patients undergoing TR, from 2014 to 2020, in the emergency service of the Hospital do Trabalhador, Curitiba - Paraná, Brazil. Results: a total of 46 TR were performed during the study period, of which 89.1% were male. The mean age of patients undergoing TR was 34.1±12.94 years (range 16 and 69 years). Penetrating trauma corresponded to the majority of indications with 80.4%, of these 86.5% victims of gunshot wounds and 13.5% victims of knife wounds. On the other hand, only 19.6% undergoing TR were victims of blunt trauma. Regarding the outcome variables, 84.78% of the patients had declared deaths during the procedure, considered non-responders. 15.22% of patients survived after the procedure. 4.35% of patients undergoing TR were discharged from the hospital, 50% of which were victims of blunt trauma. Conclusion: the data obtained in our study are in accordance with the world literature, reinforcing the need for a continuous effort to perform TR, respecting its indications and limitations in patients victims of severe penetrating or blunt trauma.

ABSTRACT Purpose: to analyze the relation between Trauma Quality Indicators (QI) and death, as well as clinical adverse events in severe trauma patients. Methods: analysis of data collected in the Trauma Register between 2014-2015, including patients with Injury Severity Score (ISS) > 16, reviewing the QI: (F1) Acute subdural hematoma drainage > 4 hours with Glasgow Coma Scale (GCS) 6 hours; (F10) Surgery > 24 hours. T the chi-squared and Fisher tests were used to calculate statistical relevance, considering p

ABSTRACT Objective: to assess the epidemiological profile of patients undergoing exploratory trauma laparotomy based on severity and prognosis criteria, and to determine the predictive accuracy of trauma scoring systems in terms of morbidity and mortality. Methods: retrospective cohort study and review of medical records of patients undergoing exploratory laparotomy for blunt or penetrating trauma at the Hospital de Pronto Socorro de Porto Alegre, from November 2015 to November 2019. Demographic data, mechanism of injury, associated injuries, physiological (RTS and Shock Index), anatomical (ISS, NISS and ATI) and combined (TRISS and NTRISS) trauma scores, intraoperative findings, postoperative complications, length of stay and outcomes. Results: 506 patients were included in the analysis. The mean age was 31 ± 13 years, with the majority being males (91.3%). Penetrating trauma was the most common mechanism of injury (86.2%), predominantly by firearms. The average RTS at hospital admission was 7.5 ± 0.7. The mean ISS and NISS was 16.5 ± 10.1 and 22.3 ± 13.6, respectively. The probability of survival estimated by TRISS was 95.5%, and by NTRISS 93%. The incidence of postoperative complications was 39.7% and the overall mortality was 12.8%. The most accurate score for predicting mortality was the NTRISS (88.5%), followed by TRISS, NISS and ISS. Conclusion: the study confirms the applicability of trauma scores in the studied population. The NTRISS seems to be the best predictor of morbidity and mortality.

ABSTRACT Purpose: to trauma quality indicators as a tool to identify opportunities of improvement in elderly trauma patient’s’ treatment. Methods: prospective analysis of data collected between 2014-2015, and stored in the iTreg software (by Ecossistemas). Trauma victims, aged older than 60 years and trauma quality indicators were assessed, based on those supported by SBAIT in 2013: (F1) Acute subdural hematoma drainage after 4 hours from admission, in patients with GCS

RESUMO Objetivo: avaliar a influência do local de ocorrência do trauma nos escores de trauma de pacientes submetidos à laparotomia de emergência. Métodos: estudo retrospectivo observacional analítico. Foram incluídos 212 pacientes submetidos à laparotomias exploratórias no período de janeiro de 2015 e dezembro de 2017. Informações sobre o local do acidente e dados vitais dos pacientes foram obtidas com base na coleta de dados por meio de prontuários eletrônicos e físicos. Foram analisados os índices de trauma de pacientes provenientes de Curitiba e Região Metropolitana e o local em que o paciente foi socorrido (estabelecimento físico ou via pública). Resultados: entre os 212 pacientes estudados, 184 (86,7%) foram trazidos pelo Serviço de Atendimento Pré-Hospitalar provenientes da cidade Curitiba e 28 (13,3%) provenientes de Região Metropolitana de Curitiba. Foram socorridos em estabelecimentos físicos 25 pacientes (17,6%), enquanto 117 (82,4%) foram socorridos em via pública. Observou-se maiores valores de ISS (Injurity Severity Score) dos pacientes procedentes da Região Metropolitana em relação aos procedentes de Curitiba (29,78 vs 22,46, P=0,009), enquanto valores maiores do TRISS (Trauma Trauma and Injury Severity Score) foram observados em pacientes procedentes de Curitiba em relação aos da Região Metropolitana (90,62 vs 81,30; P=0,015). Pacientes socorridos em via pública apresentaram menor valor de RTS (Revised Trauma Score) (6,96 vs 7,65; P=0,024) e TRISS (86,42 vs 97,21; P=0,012). Conclusão: pacientes vítimas de trauma procedentes de locais mais distantes do atendimento no centro de referência apresentaram pior prognóstico à admissão e foi observado pior prognóstico em pacientes socorridos em via pública.

Introducción. En el mundo se reconoce la importancia de los sistemas de registro de trauma. En Latinoamérica los sistemas disponibles de este tipo son poco confiables y no tienen continuidad. El del International Trauma System Development Program es el primero en implementarse en Colombia. Objetivo. Describir la experiencia de la implementación entre el 6 de enero y el 31 de julio de 2012 de un sistema de registro de trauma en dos hospitales de nivel III (equivalente al nivel I en complejidad de los hospitales en Estados Unidos) en Cali, Colombia. Método. El sistema de registro de trauma incluye información prehospitalaria y hospitalaria, y el estado al egreso del paciente, en tiempo real. Cada hospital tiene una estrategia para la captura electrónica de datos. Se presenta un análisis descriptivo y exploratorio de un ensayo piloto de siete meses. Resultados. Se registraron 9.080 pacientes en ambos hospitales. En el análisis global, el 67,1 % eran hombres; la edad promedio fue de 30 ± 20 años; el 68% eran mayores de 18 años. El 24,5 % de los pacientes fueron hospitalizados; de estos, 300 (13,5%) requirieron hospitalización en la unidad de cuidados intensivos. En cuanto a la gravedad del trauma, el 5,6 % de los pacientes tenía un puntaje de gravedad de las lesiones (Injury Severity Score, ISS) igual o mayor de 15. La tasa de mortalidad global fue del 3 %. Conclusión. Se logró la implementación del sistema de registro de trauma e identificar las causas de consulta, morbilidad y muerte por trauma. Esto contribuye al desarrollo de la investigación sobre pacientes con trauma, y a reorientar los servicios de urgencias y los del sistema regional de trauma y emergencias. Palabras clave: centros traumatológicos; índices de gravedad del trauma; puntaje de gravedad del traumatismo; registros electrónicos de salud.Introduction: The importance of the Trauma Registry System is recognized worldwide. The available TRS in Latin America are unreliable and have no continuity. The International Trauma Registry of the Panamerican Trauma Society – International Trauma System Developing Program (ITSDP) is the first one to be implemented in Colombia. Objective: To describe the experience with the implementation of a TRS at two third level of care hospitals (equivalent to complexity level I in the United States) in Cali, Colombia, in the period January 6 to July 31, 2012. Method: TRS includes prehospital, hospital, and discharge status in real-time. Each hospital has its own electronic data capture strategy. A seven-month period pilot trial descriptive analysis is presented. Results: 9,080 patients were registered, 67,1% were male; mean age was 30,2 ± 20 years, 68,0% older than 18 years; 24.5% were hospitalized, of which 300 (13,5%) required ICU. Regarding severity of trauma, 5,6% of patients had ISS ≥ 15. Overall mortality rate was 3,0%. Conclusion: Implementation of the SRT was feasible and allowed the identification the cause of presentation, morbidity, and mortality rates. This improves research on trauma better direction of the emergency and trauma services.

OBJETIVO: Descrever métodos e estimativas de mortalidade proporcional por mortes evitáveis e tipos de não conformidades do atendimento relacionadas a esses eventos. MÉTODOS: Revisão sistemática de publicações sobre mortes evitáveis em vítimas com traumatismos entre 2000 e 2009. Foi realizada pesquisa nas bases de dados Lilacs, SciELO e Medline utilizando-se a estratégia de busca com as palavras-chave "trauma", "avoidable", "preventable", "interventions" e "complications", e os descritores em ciências da saúde "death", "cause of death" e "hospitals". RESULTADOS: Identificaram-se 29 artigos publicados no período, com predomínio de estudos retrospectivos (96,5%). Os métodos mais comumente utilizados para definir a evitabilidade do óbito foram painel de especialistas ou pontuação de índices de gravidade, tendo sido empregadas as seguintes categorias: evitável, potencialmente evitável e não evitável. A média da mortalidade proporcional por mortes evitáveis dos estudos foi de 10,7% (dp 11,5%). As não conformidades mais comumente relatadas nas publicações foram sistema inadequado de atendimento ao traumatizado e erro na avaliação e tratamento. CONCLUSÕES: Observaram-se falhas na uniformização dos termos empregados para categorizar as mortes e as não conformidadades encontradas. Portanto, sugere-se a padronização da taxonomia da classificação das mortes e dos tipos de não conformidades observadas.OBJETIVO: Describir métodos y estimativas de mortalidad proporcional por muertes evitables y tipos de no concordancias de la atención relacionadas con tales eventos. MÉTODOS: Revisión sistemática de publicaciones sobre muertes evitables en víctimas con traumatismos entre 2000 y 2009. Se realizó investigación en las bases de datos Lilacs, SciELO y Medline utilizándose la estrategia de búsqueda con las palabras clave "trauma", "avoidable", "preventable", "interventions" y "complications" y los descriptores en ciencias de la salud "death", "cause of death" y "hospitals". RESULTADOS: Se identificaron 29 artículos publicados en el período, con predominio de estudios retrospectivos (96,5%). Los métodos más comúnmente utilizados para definir la prevención del óbito fueron grupo de especialistas o puntuación de índices de gravedad, y empleadas las siguientes categorías: evitable, potencialmente evitable, y no evitable. El promedio de la mortalidad proporcional por muertes evitables de los estudios fue de 10,7% (de 11,5%). Las no concordancias más comúnmente relatadas en las publicaciones fueron sistema inadecuado de atención al traumatizado y error en la evaluación y tratamiento. CONCLUSIONES: Se observó fallas en la uniformización de los términos empleados para categorizar las muertes y las no concordancias encontradas. Por lo tanto, se sugiere la estandarización de la taxonomía de la clasificación de las muertes y de los tipos de no concordancias observadas.OBJECTIVE: To describe methods of estimation and assess preventable deaths and types of errors related to health care. METHODS: A systematic review of articles on preventable trauma deaths published between 2000 and 2009 was conducted. Lilacs, SciELO and Medline databases were searched using the keywords "trauma," "avoidable," "preventable," "interventions" and "complications" and the health sciences descriptors "death," "cause of death," and "hospitals." RESULTS: A total of 29 articles published during the study period were selected. Most were retrospective studies (96.5%). The most common methods used to define avoidability of death were expert panel and injury severity scores. Deaths were categorized as follows: preventable; potentially preventable; and not preventable. The mean preventable death rate was 10.7% (SD 11.5%). The most commonly reported errors were inadequate care management of injured patients and evaluation and treatment errors. CONCLUSIONS: Inconsistent terms were used to categorize deaths and related noncompliances. It is suggested to standardize the terminology for the classification of deaths and types of errors.

This study verifies and compares the performance of three different scores obtained in the Glasgow Coma Scale (GCS) in the first 72 hours post trauma in predicting in-hospital mortality. The studied scores included those obtained after initial care was provided at the hospital, and the worst and best scores obtained in the scale in the first 72 hours post trauma. The scale’s predictive ability was assessed by the Receiver Operator Characteristic (ROC) curve. A total of 277 victims with different severity levels of blunt traumatic brain injuries were studied. The performance of the three scores that were analyzed to predict hospital mortality was moderate (0.74 to 0.79) and the areas under the curve did not present statistically significant differences. These findings suggest that any of the three studied scores can be applied in clinical practice to estimate the outcome of victims with blunt traumatic brain injuries, taking into consideration the instrument’s moderate discriminatory power.El estudio tiene como objetivos verificar y comparar el desempeño de puntajes de la Escala de Coma de Glasgow (ECGl) observados en las primeras 72 horas postrauma para predecir la mortalidad hospitalaria. Los valores analizados fueron los puntajes obtenidos después de la atención inicial intra-hospitalaria, además de los peores y mejores resultados de la escala en las primeras 72 horas postrauma. La capacidad de predicción de los puntajes de la ECGl para el Estado Vital a la Salida Hospitalaria fue evaluada, utilizando la curva Reciever Operator Characteristic. Fueron estudiadas 277 víctimas, con trauma encefalocraneano contuso de diferentes gravedades. El desempeño de los puntajes de la ECGl para el estado vital a la salida hospitalaria fue moderado (0,74 a 0,79) y las áreas bajo la curva no presentaron diferencia significativa. Los resultados sugieren que cualquiera de los tres valores de la ECGl analizados pueden ser aplicados en la práctica clínica para estimar el pronóstico de las víctimas de trauma encefalocraneano contuso, considerando, sin embargo su moderado poder discriminatorio.O estudo teve como objetivos verificar e comparar o desempenho de escores da Escala de Coma de Glasgow (ECGl) observados nas primeiras 72 horas após trauma, para predizer mortalidade hospitalar. Os valores analisados foram os escores obtidos após atendimento inicial intra-hospitalar, além dos piores e melhores resultados da escala nas primeiras 72 horas pós-trauma. A capacidade preditiva dos escores da ECGl para estado vital à saída hospitalar foi avaliada, utilizando-se a curva Reciever Operator Characteristic. Foram estudadas 277 vítimas, com trauma cranioencefálico contuso de diferentes gravidades. O desempenho dos escores da ECGl para estado vital à saída hospitalar foi moderado (0,74 a 0,79) e as áreas sob a curva não apresentaram diferença significativa. Os resultados sugerem que qualquer um dos três valores da ECGl analisados podem ser aplicados na prática clínica para estimar o prognóstico das vitimas de trauma cranioencefálico contuso, considerando-se, no entanto, seu moderado poder discriminatório.

OBJETIVOS: Avaliar pacientes tratados por lesões traumáticas e identificar a adesão às recomendações de diretrizes de tratamento e sua associação com óbito. As recomendações adotadas foram as definidas pelo comitê de Trauma do American College of Surgeons para suporte avançado de vida no trauma. MÉTODOS: Este foi um estudo de coorte retrospectivo realizado em um hospital de ensino. A população do estudo foi constituída por vítimas de traumatismo com idade igual ou superior a 12 anos e com escores de gravidade da lesão > 16 tratados entre janeiro de 1997 e dezembro de 2001. A coleta de dados foi dividida em três fases: pré-hospitalar, intra-hospitalar e post-mortem. Os dados colhidos foram analisados com o software EPI INFO. RESULTADOS: Analisamos 207 pacientes, 147 vítimas de traumatismo fechado (71%) e 60 (29%) vítimas de traumatismo penetrante. As vítimas de traumatismo tiveram uma taxa de mortalidade de 40,1%. Identificamos 221 eventos de não adesão que ocorreram em 137 pacientes. Identificamos uma média de 1,61 ocorrências de não adesão por paciente, que ocorreu menos frequentemente entre os que sobreviveram (1,4) do que entre os que não sobreviveram (1,9; p=0,033). Segundo a metodologia de escore de gravidade da lesão, 54,2% dos óbitos foram considerados potencialmente evitáveis. A não adesão ocorreu 1,77 vezes mais frequentemente nos óbitos que foram considerados potencialmente evitáveis em comparação aos demais não-sobreviventes (IC 95%: 1,12 - 2,77; p=0,012) e 92,9% das ocorrências múltiplas de não adesão ocorreram no primeiro grupo (p=0,029). CONCLUSÕES: A falta de adesão às diretrizes ocorreu com maior freqüência em pacientes com óbitos potencialmente evitáveis. O não cumprimento das recomendações das diretrizes pode ser considerado um fator contribuinte para a morte em vítimas de traumatismo, e pode levar a um maior número de mortes potencialmente evitáveis.OBJECTIVES: To evaluate patients treated for traumatic injuries and to identify adherence to guidelines recommendations of treatment and association with death. The recommendations adopted were defined by the committee on trauma of the American College of Surgeons in advanced trauma life support. METHODS: Retrospective cohort study conducted at a teaching hospital. The study population was victims of trauma > 12 years of age with injury severity scores > 16 who were treated between January 1997 and December 2001. Data collection was divided into three phases: pre-hospital, in-hospital, and post-mortem. The data collected were analyzed using EPI INFO. RESULTS: We analyzed 207 patients, 147 blunt trauma victims (71%) and 60 (29%) penetrating trauma victims. Trauma victims had a 40.1% mortality rate. We identified 221 non adherence events that occurred in 137 patients. We found a mean of 1.61 non adherence per patient, and it occurred less frequently in survivors (1.4) than in non-survivors (1.9; p=0.033). According to the trauma score and injury severity score methodology, 54.2% of deaths were considered potentially preventable. Non adherence occurred 1.77 times more frequently in those considered potentially preventable deaths compared to other non-survivors (95% CI: 1.12-2.77; p=0.012), and 92.9% of the multiple non adherence occurred in the first group (p=0.029). CONCLUSIONS: Non adherence occurred more frequently in patients with potentially preventable deaths. Non adherence to guidelines recommendations can be considered a contributing factor to death in trauma victims and can lead to an increase in the number of potentially preventable deaths.

Introducción. Existe un amplio uso de la escala Injury Severity Score (ISS) como factor predictor de mortalidad en trauma. Algunos reportes han mostrado que es pobre factor predictor en pacientes con lesiones penetrantes graves. Recientemente, se ha usado el New Injury Severity Score (NISS) y se ha comparado con el ISS en trauma cerrado grave y trauma penetrante. Objetivo. Evaluar el comportamiento del NISS y del ISS en pacientes con trauma penetrante grave llevados a laparotomía de control de daños y en laparotomía convencional no de control de daños. Materiales y métodos. Se incluyeron pacientes adultos del Registro DAMACON. El NISS fue calculado retrospectivamente. Mediante un modelo de regresión logística se construyó la curva ROC (receiver operating characteristics) y el área bajo la curva (AUC) para comparar la capacidad discriminatoria de ambas escalas. Resultados. Se incluyeron 214 pacientes, 93 (43,4%) necesitaron laparotomía de control de daños. Entre los grupos, no hubo diferencias en la edad (32,3±10 años Vs. 30,3±10, p=0,12); ni en el sexo masculino (92,5% Vs. 90,1%, p=0,45). La gravedad del trauma por Revised Trauma Score (RTS) fue mayor en el grupo de laparotomía de control de daños comparado con el grupo de laparotomía convencional no de control de daños (6,21,9 Vs. 7,1±1,2, p=0,0022) al igual que la mortalidad a 30 días (35,5% Vs. 3,3%, pIntroduction. Despite the wide use of ISS as a mortality predictive score in trauma, several reports have shown that ISS is a poor predictor of outcome especially in patients with severe penetrating injuries. More recently, the use of New ISS (NISS) has been compared with ISS in blunt severe trauma and mild penetrating trauma. The purpose of this study was to evaluate the performance of NISS and ISS in patients with severe penetrating trauma, both in damage control (DC) and not damage control (no-DC) surgery. Methods. Consecutive adult patients with penetrating trauma and surgery were identified over a 6-years period (2003-2008) in our prospective trauma single center registry (DAMACON). NISS was estimated retrospectively. Logistic regression was used to construct ROC curves and areas under the curve (AUC) in order to compare the discriminative capacity among scores by type of surgical approach. Results. A total of 214 patients with penetrating trauma, 93 (%) needed DC surgery. Mean age for DC group was of 32.3±10 years old, RTS was 6.2±1.9, and 30 days mortality was of 35.5%. Compared with non-DC patients with mean age of 30.3±10.9 years old, RTS was 7.1±1.2 and 30 days mortality of 3.3%. NISS and ISS AUC were 0.86 and 0.72 respectively (P=0.01), for non-DC group; and 0.71 and 0.76 in DC group. Conclusion. NISS showed an improved performance for mortality prediction over ISS in the subgroup of patients with non-DC surgery for penetrating trauma, but not in DC setting. Furthermore, overall performance of the scores was sub-optimal in this setting. More efforts have to be made to identify new prognostic factors for this subgroup of very ill patients.

O trauma crânio-encefálico contuso (TCEC) é freqüentemente seguido pela amnésia pós-traumática (APT), caracterizada como um estado transitório de confusão e desorientação. Sua duração tem sido utilizada para quantificar a gravidade do TCEC e prever distúrbios nas funções cognitivas, assim como para antever as alterações na capacidade funcional das vítimas pós-trauma. O Galveston Orientation Amnesia Test (GOAT) é o primeiro instrumento sistematizado criado e o mais amplamente utilizado para avaliar a APT. Este artigo apresenta esse instrumento, as bases conceituais para seu desenvolvimento e a adaptação e validação do GOAT para cultura brasileira. Além disso, descreve sua aplicação e comenta as restrições do seu uso. Resultados de pesquisas realizadas em nosso meio contribuíram para as evidências sobre a validade do GOAT. Também apontaram os indicadores do momento pós-trauma em que o GOAT deve ser aplicado e destacaram as dificuldades no uso desse instrumento.El trauma cráneo-encefálico contuso (TCEC) es frecuentemente seguido por la amnesia pos-traumática (APT), caracterizada como un estado transitorio de confusión y desorientación. Su duración ha sido utilizada para cuantificar la severidad del TCEC y prever alteraciones en las funciones cognitivas, tanto como para antever las dificultades en la capacidad funcional de las víctimas pos-trauma. El Galveston Orientation Amnésia Test (GOAT) es la primera encuesta sistematizada que fue creada y el mas ampliamente utilizada para evaluar la APT. Esta publicación presenta esta encuesta, las bases conceptuales para su desarrollo y la adaptación y validación del GOAT para la cultura brasileña. Además, describe su aplicación y limitaciones en el uso. Resultados de pesquisas brasileñas contribuyeron para las evidencias sobre la validad del GOAT. También apuntaron los indicadores del momento pos-trauma en que el GOAT debe ser aplicado y destacaron las dificultades en el uso de esa encuesta.Closed head injury (CHI) is frequently followed by post-traumatic amnesia (PTA) and is characterized by a transitory state of confusion and disorientation. The PTA duration has been used to quantify the CHI severity and to predict disorders in cognitive functions, as well as to foresee any alteration in the functional capacity of post-trauma victims. The Galveston Orientation Amnesia Test (GOAT) is the first systematized instrument created, and the most broadly applied, to assess PTA. This article presents the GOAT, the conceptual basis for the development of the instrument, and its adaptation and validation to the Brazilian culture. In addition, the article describes the application of the instrument and makes comments on the restrictions of its use. Brazilian research results showed evidences of the GOAT's validity. They also point to the indicators of post-trauma conditions in which the GOAT must be applied, and highlight the difficulties in the application of the instrument.

This study compared the performance of the Injury Severity Score (ISS) with the New Injury Severity Score (NISS) and also the Simplified Acute Physiology Score II (SAPS II) with the Logistic Organ Dysfunction System (LODS) in trauma victims, in order to predict mortality and length of stay in Intensive Care Units (ICU), besides identifying which indexes have been the most effective to estimate these results. A retrospective analysis was done in the records of 185 victims admitted in ICU between June and December 2006. None of the four indexes properly discriminated the patients according to length of stay at the ICU. The ISS and the NISS did not show a good discriminating capacity in case of death, but the SAPS II and the LODS presented good performance to estimate mortality at the ICU. Results pointed towards the use of SAPS II and LODS when trauma victims are admitted in an ICU.Este estudio tuvo por objetivo comparar en víctimas de trauma el desempeño del Injury Severity Score (IS), con el New Injury Severity Score (NIS) y, también, del Simplified Acute Physiology Score II (SAPS II), con el Logistic Organ Dysfunction System (LODS) para predecir la mortalidad y el tiempo de permanencia en unidades de terapia intensiva (UTI), y también para identificar cuales índices fueron los más efectivos para estimar esos resultados. Fue realizado un análisis retrospectivo de las fichas de 185 víctimas, admitidas en una UTI, entre junio y diciembre de 2006. Los cuatro índices no discriminaron adecuadamente a los pacientes según el tiempo de permanencia en la UTI. El IS y el NIS no mostraron una buena capacidad discriminatoria para la ocurrencia de muerte, diferente del SAPS II y del LODS que presentaron un mejor desempeño para estimar la mortalidad en UTI. Los resultados apuntaron para el uso del SAPS II y del LODS cuando víctimas de trauma son internadas en una UTI.Este estudo objetivou comparar em vítimas de trauma o desempenho do Injury Severity Score (ISS), perante o New Injury Severity Score (NISS) e, também, do Simplified Acute Physiology Score II (SAPS II), perante o Logistic Organ Dysfunction System (LODS) para predizer a mortalidade e o tempo de permanência em unidades de terapia intensiva (UTI), além de identificar quais índices foram os mais efetivos para estimar esses desfechos. Foi realizada análise retrospectiva dos prontuários de 185 vítimas, admitidas em UTI, entre junho e dezembro de 2006. Os quatro índices não descriminaram adequadamente os pacientes segundo tempo de permanência na UTI. ISS e NISS não mostraram boa capacidade discriminatória para ocorrência de óbito, diferente do SAPS II e LODS que apresentaram melhor performance para estimar a mortalidade em UTI. Resultados apontaram para o uso do SAPS II e do LODS quando vítimas de trauma são internadas em UTI.

Trata-se da análise das lembranças do período de internação referidas pelos pacientes que sofreram TCE de diferentes gravidades. O estudo foi realizado no ambulatório de Trauma de Crânio do Instituto Central do HC-FMUSP com amostra de 45 pacientes conscientes e capazes de manter entrevista. Predominaram pacientes do sexo masculino, adultos jovens, que tiveram como causas acidentes de trânsito e quedas. A maioria (86,0%) informou ter ficado desacordada em diferentes tempos de duração e nada recordar deste período. Naqueles que sempre estiveram alertas ou que acordaram ainda internados as lembranças relacionaram-se com ter visto, sentido, ouvido ou reagido a sons e procedimentos.Se estudiaron los recuerdos que enfermos de TCE de distinta gravedad tienen del periodo de hospitalización. El estudio fue realizado en el servicio de consulta externa de traumatismo del Cráneo del Instituto Central del HC - FMUSP y fueron entrevistados 45 enfermos conscientes y capaces de contestar preguntas. La mayoría de los enfermos eran del sexo masculino, jóvenes y víctimas de accidentes de tránsito y caídas. La mayoría de los enfermos (86%) dijeron no estar despiertos en todos los momentos y que no se recordaban de nada del periodo. Los recuerdos relatados por los que estuvieron despiertos y también por aquellos que se despertaron durante la hospitalización, eran sobre todo mirar, sentir, oír o reaccionar a sonidos y procedimientos.Traumatic brain injured (TBI) patients with different trauma severity were analyzed about their recollection concerning the period of hospitalization. The study was carried out in the Head Injury Outpatient Clinic at the Central Institute of the FMUSP Hospital including 45 conscious patients able to sustain an interview. Most patients were male, young adults with the major cause of trauma such as traffic accidents and falls. Most patients (86%) reported uncosciouness state of different time duration in their hospitalization period and were unable to remember anything related to that period. The predominant recollection reported by the patients who never had consciousness decreased after the trauma and that ones who had it but awoke during the hospitalization were: seeing, feeling, hearing, and reacting either to sounds and procedures.

OBJETIVO: Caracterizar as diferenças das vítimas com diagnóstico de traumatismo crânio-encefálico envolvidas em diferentes condições, em acidentes de trânsito de veículo a motor e evidenciar indicadores para prevenção e seu atendimento. MÉTODO: Foram analisados os prontuários de todas as vítimas com diagnóstico de trauma crânio-encefálico, assistidas em hospital de referência para atendimento do trauma, entre março e junho de 1993. A população foi de 156 vítimas, sendo 80 pedestres, 50 ocupantes de veículos a motor, exceto de moto e, 26 motociclistas ou passageiros de motos. RESULTADOS E CONCLUSÕES: Os resultados mostraram que a mortalidade entre pedestres foi a mais alta entre os três grupos (25,0%). Os óbitos ocorrem em 19,2% dos ocupantes de motocicleta e 8,0% dos ocupantes de demais veículos a motor. Foram observadas diferenças estatísticas entre os grupos quando a variável gravidade do trauma crânio-encefálico foi analisado. Análise de certas variáveis mostraram importantes diferenças na distribuição dos três grupos.OBJECTIVE: The purpose of this study was to discover the differences among victims who had traumatic brain injury due to traffic accidents. METHOD: Medical records of the head injury patients were analyzed according to their classification as traffic accident victims (pedestrian, motorcyclist or passenger and other motor vehicle driver or passenger), age, gender, admission type (admitted from scene of the injury or from another hospital), duration of hospitalization, type of head injury, types of lesions present in other body segments and mortality. Patient’s injury severity was measured by Injury Severity Score and head injury severity was analyzed using the ranking on the Glasgow Coma Scale, recorded by neurosurgeons during their first neuro assessment. All head injured patients admitted to a trauma center in S. Paulo city over a four-month period from March through June 1993, were included in the study. The sample was of 156 victims, with subsets of 80 pedestrians, 26 occupants of motorcycles and 50 occupants of other motor vehicles. RESULTS AND CONCLUSIONS: The results of this study showed that the mortality rate was higher in the pedestrian subset (25,0%) than among other victims and higher for motorcycle occupants (19,2%) than for motor vehicle victims (8,0%). Statistical differences between the subsets were established when the head injury severity variable was analyzed using the Glasgow Coma Scale. On the other hand, the differences between the three subsets was not statistically significant when the measurement used was the Injury Severity Score. Analyses of other variables showed important differences among subset distributions.

Objectives: To study whether combining age and the Glasgow Coma Scale (GCS) with the shock index (SI) - SIA/G - during the initial care of polytraumatized patients can improve the ability of the SI alone to predict mortality. To compare the predictive performance of the SIA/G combination to other prognostic scales: the addition of points for the GCS, age and systolic blood pressure (GAP); the Revised Trauma Score (RTS); and the Injury Severity Score (ISS)., Material and Methods: Observational cohort study of patients with severe trauma admitted to the intensive care unit of a tertiary care hospital between 2015 and 2020. We calculated the SI (heart rate/systolic blood pressure), the SI/G ratio, the product of the SI and age SIA, and the combined index: SIA/G. The areas under the receiver operating characteristic curves (AUROCs) for hospital mortality and 24-hour mortality were calculated for the SIA/G combination and compared to the AUROCs for the GAP, the RTS, and the ISS., Results: We analyzed data for 433 patients, 47 of whom (10.9%) died. All the prognostic indexes were significantly related to mortality but the SIA/G was the best predictor of both hospital and 24-hour mortality, with AUROCs of 0.879 (95% CI, 0.83-0.93) and 0.875 (95% CI, 0.82-0.93), respectively. A score of 3.3 for the SIA/G showed 82% sensitivity and 80% specificity for hospital mortality (86% and 78%, respectively, for 24-hour mortality). The AUROCs for the GAP, RTS, and ISS indexes were lower for hospital mortality., Conclusion: The combined SIA/G score is a better predictor in hospital of mortality in patients with multiple injuries than the SI or the traditional GAP, RTS, and ISS indexes.

Objective: To analyze the risk factors for death of trauma patients admitted to the intensive care unit (ICU)., Method: Retrospective cohort study with data from medical records of adults hospitalized for trauma in a general intensive care unit. We included patients 18 years of age and older and admitted for injuries. The variables were grouped into levels in a hierarchical manner. The distal level included sociodemographic variables, hospitalization, cause of trauma and comorbidities; the intermediate, the characteristics of trauma and prehospital care; the proximal, the variables of prognostic indices, intensive admission, procedures and complications. Multiple logistic regression analysis was performed., Results: The risk factors associated with death at the distal level were age 60 years or older and comorbidities; at intermediate level, severity of trauma and proximal level, severe circulatory complications, vasoactive drug use, mechanical ventilation, renal dysfunction, failure to perform blood culture on admission and Acute Physiology and Chronic Health Evaluation II., Conclusion: The identified factors are useful to compose a clinical profile and to plan intensive care to avoid complications and deaths of traumatized patients.

Introduction: The aim of this study was to assess the results and adverse effects of bromocriptine in patients with traumatic brain injury-vegetative state (TBI-VS) or traumatic brain injury-minimally conscious state (TBI-MCS)., Methods: We conducted a retrospective review of 10 patients, six with TBI-VS and four with TBI-MCS. All patients received bromocriptine at a starting dose of 2.5mg twice daily. Bromocriptine was titrated up to 7.5 or 12.5mg twice daily according to response and was maintained for at least 4 weeks. Various assessment scales were used in the following stages: before bromocriptine administration, at 4 weeks post bromocriptine prescription, and at hospital discharge. The assessment scales used were the Coma Recovery Scale-Revised (CRS-R), Disability Rating Scale, Glasgow Coma Scale, Barthel Scale, and Marshall Scale., Results: Of the 10 patients, four with TBI-MCS and four with TBI-VS achieved a score of 23 points at discharge in the CRS-R, thus emerging from VS or MCS and regaining functional status. There were only two patients who emerged from VS but remained in MCS (8 to 11 and 5 to 10 points in CRS-R)., Conclusions: Considering the poor prognosis for recovery in these patients, bromocriptine use has a positive risk-benefit ratio at a dosage of at least 7.5mg twice daily for 4 weeks., (Copyright © 2019 Sociedad Española de Rehabilitación y Medicina Física. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To describe the epidemiology of interpersonal violence in Spain., Method: Descriptive study of the cases of patients with secondary diagnosis of aggression registered on a national hospital discharge database, between 1999 and 2011, using the codes from E960 to E969 of the ICD-9. The distribution by sex, age and type of discharge, associated morbidity, mortality and by autonomous community is described. The quality of the record is studied according to its temporal variation., Results: The case profile of aggression in men (85%) is of a patient between 15 and 44 years old, who in 93.7% of cases requires urgent care and whose severity is moderate (95% discharge home). Two point five percent of patients are readmitted and death occurs in1.1%. The profile in women (15%) differs slightly, with an age between 31 and 52 years, 94% require urgent attention, although 96% have moderate severity; 3% are readmitted and 1.7% die., Conclusions: Although they need to be improved to avoid certain limitations, health information systems are a rich source of data that can be used for research in health and, through their results, for the development of prevention plans and intervention in matters of violence., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: To describe the abdominal injuries treated in our hospital. We assessed the behavior and reliability of prognostic scales, analyzing the correlations between them and therapeutic decisions and outcomes., Material and Methods: Retrospective study including all patients with major abdominal injuries admitted to our hospital between 2009 and 2015. We gathered epidemiologic and clinical data, outcomes, and scores on several prognostic scales., Results: The median age of the 153 patients we identified from case records was 38 years; 73.9% were males. Most cases involved blunt trauma (94.1%) sustained in traffic accidents (60.1%). The spleen and the liver were the organs most often affected (in 44.4% and 36.6%, respectively). The median length of stay in the hospital was 11 days, and overall mortality was 13%. Although conservative management was successful in 62.7% of the cases, we found that patients who had a higher ISS (Injury Severity Score) or TRISS (Trauma and Injury Severity Score) assessments more often required surgery or died (P=.0001, both comparisons). Those who had longer hospital stays had a higher Revised Trauma Score or TRISS (P=.001 and P=.016, respectively)., Conclusion: . The causes of abdominal injuries and the types treated in our hospital were similar to those described for the rest of Spain. Punctuation on prognostic severity scales correlated directly with the need for surgery, length of hospital stay, complications, and mortality.

Objective: To identify the changes in the epidemiology of traumatic brain injury (TBI) in a cohort of patients older than 65 years old admitted in the Intensive care unit of a third-level hospital over a 25 year period., Material and Methods: A retrospective cohort study conducted on patients over 65 years-old admitted with the diagnosis of TBI into an intensive care unit of a Spanish university hospital. The demographic, clinical variables were collected at the time of admission, including comorbidities, injury mechanisms, and injuries presented, and days of stay in ICU. A statistical analysis was carried out by five-year periods., Results: A total of 446 TBI in patients over 65 years were included. In the analysis, an increase was observed in the proportion of patients presenting with epidural haematoma (1.39% in the period 1990-1995 vs. 9.46% in 2010-2015), with a significant linear tendency (P=.018). Falls from own height have increased from 8.33% (1991-1995) to currently more than 70% (2011-2015), P<.001. The percentage of traffic accidents declined from 26.39% to 3.95% in the last period, P<.001., Conclusions: In the last 25 years there seems to be evidence of a change in the origins of TBI in the elderly in our field., (Copyright © 2018 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introducción. El manejo no operatorio del trauma esplénico cerrado es el método preferencial para la preservación esplénica; sin embargo, los criterios para decidir qué pacientes pueden ser manejados sin cirugía sigue siendo materia de debate. El objetivo de este estudio fue describir las características generales de estos pacientes, los resultados del manejo no operatorio y explorar los factores asociados a su falla. Métodos. Es un estudio descriptivo de los pacientes con diagnóstico de trauma esplénico cerrado, admitidos a un centro de atención de alta complejidad, durante el periodo comprendido entre enero de 2003 y marzo de 2009. Los pacientes se clasificaron en dos grupos: manejo operatorio y manejo no operatorio; en el último se analizaron los pacientes en los que falló dicho manejo. Un valor de p menor de 0,05 se consideró de significancia estadística. Resultados. Se incluyeron 82 pacientes. Después de la evaluación primaria o secundaria, el 25,6 % recibió manejo operatorio y, el 74,4 %, manejo no operatorio; el tratamiento no quirúrgico falló en el 22,9 %. Esta falla se asoció con un puntaje Injury Severity Score (ISS) mayor o igual a 20 (RR=6,4; IC95% 2,34-17,86), presencia de hemoperitoneo en la tomografía axial de ingreso (p=0,02) y el grado de lesión esplénica (p

OBJETIVO: Analisar a evolução do trauma hepático fechado e comparar o tratamento operatório e não operatório em pacientes admitidos com estabilidade hemodinâmica e nenhuma indicação óbvia de laparotomia. MÉTODOS: Estudo retrospectivo de casos admitidos em um hospital universitário entre 2000 e 2010. Os pacientes submetidos ao tratamento operatório foram distribuídos em dois grupos: a) todos os pacientes submetidos ao tratamento cirúrgico e b) pacientes sem indicações óbvias de laparotomia. RESULTADOS: Neste período, 120 pacientes foram admitidos com trauma hepático fechado. Sessenta e cinco pacientes (54,1%) foram submetidos ao tratamento não operatório e 55 pacientes foram operados. Pacientes submetidos ao tratamento não operatório tiveram melhores parâmetros fisiológicos na admissão, menor gravidade de lesões (exceto pelo grau de lesão hepática), menor necessidade de transfusão sanguínea e menor morbidade e mortalidade quando comparados aos pacientes operados. Os pacientes operados sem indicação óbvia de cirurgia tiveram maiores taxas de complicações e mortalidade do que os pacientes submetidos ao tratamento não operatório. CONCLUSÃO: O tratamento não operatório resultou em menor taxa de complicações, menor necessidade de transfusão sanguínea e menor mortalidade.

OBJETIVO: Realizar uma análise comparativa entre os principais mecanismos de trauma, a gravidade das vítimas e os principais ferimentos que proporcionaram. MÉTODO: Estudo randomizado de 1486 fichas de vítimas traumatizadas atendidas pela Unidade de Resgate do Corpo de Bombeiros em Catanduva - SP, no período de janeiro/1997 a dezembro/2003. Foi realizada uma avaliação a partir dos itens ferimentos, Revised Trauma Score e mecanismos de trauma, cujas variáveis foram expressas em porcentagens e correlacionadas pelo Teste X². RESULTADOS: Houve predomínio de acidentes motociclísticos com 42,2% dos traumas. As regiões corpóreas mais acometidas foram os membros inferiores/cintura pélvica (32,2%). Os ferimentos superficiais acometeram 88% das vítimas. Para todos os eventos, prevaleceram vítimas com RTS=6 excetuando-se os acidentes envolvendo veículos pesados em que 25% das vítimas obtiveram RTS

ABSTRACTObjective:to analyze the implementation of a trauma registry in a university teaching hospital delivering care under the unified health system (SUS), and its ability to identify points for improvement in the quality of care provided.Methods:the data collection group comprised students from medicine and nursing courses who were holders of FAPESP scholarships (technical training 1) or otherwise, overseen by the coordinators of the project. The itreg (ECO Sistemas-RJ/SBAIT) software was used as the database tool. Several quality "filters" were proposed to select those cases for review in the quality control process.Results:data for 1344 trauma patients were input to the itreg database between March and November 2014. Around 87.0% of cases were blunt trauma patients, 59.6% had RTS>7.0 and 67% ISS

ABSTRACTObjective:to compare the frequency and the severity of diagnosed injuries between pedestrians struck by motor vehicles and victims of other blunt trauma mechanisms.Methods:retrospective analysis of data from the Trauma Registry, including adult blunt trauma patients admitted from 2008 to 2010. We reviewed the mechanism of trauma, vital signs on admission and the injuries identified. Severity stratification was carried using RTS, AIS-90, ISS e TRISS. Patients were assigned into group A (pedestrians struck by motor vehicle) or B (victims of other mechanisms of blunt trauma). Variables were compared between groups. We considered p

ABSTRACTObjective:to evaluate the safety and effectiveness of non-operative management (NOM) of liver injury, being the only abdominal injury, from gunshot wounds to the abdomen.Methods:patients who had liver damage diagnosed as single abdominal injury caused by PAF in the right thoracoabdominal region, hemodynamically stable were studied. All underwent examination with computed tomography. Were analyzed: age, gender, levels of trauma, hemodynamic condition and the abdominal examination on admission, the results of the CT scan, the extra-abdominal lesions found, the serum levels of hemoglobin, clinical course, complications, length of hospital stay, outpatient treatment and death.Results:during the study period 169 patients, treated non-operatively, presented liver gunshot wounds. Of these, only 28 patients (16.6%) had liver injury as the only abdominal injury and consequently met the inclusion criteria for this study. The average age was 27.7 years and 25 patients (89.2%) were male. The overall average of verified trauma scores were: RTS 7.45, ISS 10.9, and TRISS 98.7%. The most frequent injuries were grade II and grade III (85.7%). Complications occurred in only one patient who presented a progressive decline in hemoglobin. He underwent a CT scan which showed blush in the liver parenchyma. An arteriography was performed, which showed a successfully embolized arteriovenous fistula. There were no deaths in the patient sample. The average hospital stay was 5.3 days.Conclusion:isolated hepatic injury in gunshot abdominal trauma is uncommon. However, the NOM protocol for this type of injury is safe and has low morbidity. This approach should only be followed in institutions with adequate infrastructure, where an experienced and cohesive team is able to follow a specific protocol, with rigorous periodic evaluation of its results.

OBJETIVO: Avaliar os fatores preditivos de morbimortalidade em pacientes com trauma duodenal. MÉTODOS: Estudo descritivo retrospectivo de 77 pacientes com lesão traumática de duodeno, em um hospital universitário, de janeiro de 1990 a dezembro de 2005. As lesões Grau I foram excluídas. RESULTADOS: O mecanismo de trauma foi penetrante em 87% dos casos e fechado em 13%, sem diferença estatisticamente significativa na mortalidade nestes grupos. Atraso maior que seis horas entre o trauma e a cirurgia foi observado em 7,8% dos casos e não influenciou na evolução dos pacientes. O reparo primário da lesão duodenal foi realizado em 84,4% dos pacientes e os procedimentos complexos em 15,6%, com maior índice de mortalidade no último grupo. A média do ATI foi de 34,5 e a do ISS foi de 22,8. As taxas de morbidade e de mortalidade foram, respectivamente, 61% e 27,3%. A maioria dos pacientes que evoluíram a óbito apresentou-se com choque hipovolêmico na admissão, possuia baixo RTS, elevados ATI e ISS, e baixo TRISS quando comparados aos sobreviventes. Choque hipovolêmico, RTS alterado, lesões associadas e probabilidade de sobrevivência menor que 50% foram considerados fatores independentes associados à mortalidade. CONCLUSÃO: A morbidade associada ao trauma duodenal neste estudo foi dependente de lesões intra-abdominais associadas, contaminação da cavidade peritoneal e reparos complexos da lesão duodenal. A apresentação fisiológica do paciente, gravidade das lesões (ISS > 25) e TRISS foram importantes fatores preditivos de morbidade e mortalidade em traumatizados com lesão duodenal.

OBJECTIVE:to identify predictors of death in blunt trauma patients sustaining pelvic fractures and, posteriorly, compare them to a previously reported series from the same center.METHOD: Retrospective analysis of trauma registry data, including blunt trauma patients older than 14 y.o. sustaining pelvic fractures admitted from 2008 to 2010. Patients were assigned into group 1 (dead) or 2 (survivors). We used Student's t, qui square and Fisher's tests for statistical analysis, considering p

OBJETIVO: Caracterizar as diferenças das vítimas com diagnóstico de traumatismo crânio-encefálico envolvidas em diferentes condições, em acidentes de trânsito de veículo a motor e evidenciar indicadores para prevenção e seu atendimento. MÉTODO: Foram analisados os prontuários de todas as vítimas com diagnóstico de trauma crânio-encefálico, assistidas em hospital de referência para atendimento do trauma, entre março e junho de 1993. A população foi de 156 vítimas, sendo 80 pedestres, 50 ocupantes de veículos a motor, exceto de moto e, 26 motociclistas ou passageiros de motos. RESULTADOS E CONCLUSÕES: Os resultados mostraram que a mortalidade entre pedestres foi a mais alta entre os três grupos (25,0%). Os óbitos ocorrem em 19,2% dos ocupantes de motocicleta e 8,0% dos ocupantes de demais veículos a motor. Foram observadas diferenças estatísticas entre os grupos quando a variável gravidade do trauma crânio-encefálico foi analisado. Análise de certas variáveis mostraram importantes diferenças na distribuição dos três grupos.

OBJETIVO: avaliar os aspectos epidemiológicos, conduta, morbidade e resultados do tratamento trauma hepático. MÉTODOS: estudo retrospectivo de doentes com mais de 13 anos de idade admitidos em um hospital universitário de 1990 a 2010, submetidos ao tratamento cirúrgico ou não operatório (TNO). RESULTADOS: foram admitidos 748 pacientes com trauma hepático. O mecanismo de trauma mais frequente foi o trauma penetrante (461 casos; 61,6%). O trauma fechado ocorreu em 287 pacientes (38,4%). De acordo com o grau de lesão hepática (AAST-OIS), no trauma fechado foi observada uma predominância dos graus I e II e no trauma penetrante, uma predominância do grau III. O TNO foi realizado em 25,7% dos pacientes com trauma hepático contuso. Entre os procedimentos cirúrgicos, a sutura foi realizada com maior frequência (41,2%). A morbidade relacionada ao fígado foi 16,7%. A taxa de sobrevida para pacientes com trauma hepático fechado foi 73,5% e no trauma penetrante de 84,2%. A mortalidade no trauma complexo foi 45,9%. CONCLUSÃO: o trauma permanece mais incidente nas populações mais jovens e no sexo masculino. Houve uma redução dos traumas hepáticos penetrantes. O TNO se mostrou seguro e efetivo, e, frequentemente, foi empregado para tratar os pacientes com trauma hepático penetrante. A morbidade foi elevada e a mortalidade foi maior em vítimas de traumas contusos e em lesões hepáticas complexas.

OBJETIVO: Analisar os pacientes submetidos à toracotomia para o tratamento de traumatismo torácico. MÉTODOS: Estudo retrospectivo por meio da análise de prontuários nos dois principais hospitais de referência para trauma em adultos desta cidade, por um período de cinco anos, interessando dados epidemiológicos, agente causal, indicações, tipo de incisão, classificação do escore anatômico do trauma, fatores prognósticos e a mortalidade. RESULTADOS: Foi analisado neste estudo 124 pacientes submetidos à toracotomia com idade média de 28 anos, tendo como o agente causal mais incidente a arma branca (68% dos casos). A principal indicação da toracotomia foi hemotórax maciço com 50,7% dos casos, seguido de choque cardiogênico ou hipovolêmico com 48,4%. Ocorreram 28 óbitos (20,6%), sendo que os pacientes com lesões de veia cava (cinco pacientes) e aorta (dois pacientes) tiveram uma mortalidade de 100%. Observou-se uma maior mortalidade em pacientes com escore anatômico do trauma superior a 14 (p=0,004) e maior quantidade de sangue transfundido (p=0,090). CONCLUSÃO: O perfil do paciente que foi vítima de traumatismo torácico e submetido à toracotomia exploradora é o seguinte: jovem, do sexo masculino e vítima de trauma por arma branca. Os fatores que mais contribuíram para o êxito letal foram o elevado escore anatômico do trauma e a associação com lesões vasculares importantes, como da artéria aorta e veia cava.

A reunião de revista "Telemedicina Baseada em Evidência - Cirurgia do Trauma e Emergência" (TBE-CiTE) realizou uma revisão crítica da literatura e selecionou três artigos atuais sobre o tratamento do trauma renaldefinido como graus III a V pela classificação da Associação Americana de Cirurgia do Trauma (AAST). O primeiro trabalho propõe subestratificação da lesão renal AAST grau IV em 4a (baixo risco) e 4b (alto risco). O segundo trabalho revisa o atual sistema de classificação de lesão renal AASTpara incluir lesões vasculares segmentares e estabelecer uma definição mais detalhada dos graus IV e V. O último artigo analisa a angiografia diagnóstica e angioembolização na fase aguda do trauma renal utilizando dados americanos. A reunião de revista TBE-CiTE elaborou as conclusões e recomendações para o tratamento do trauma renal de alto grau.

OBJETIVO: avaliar os fatores preditivos de lesões abdominais graves (LAG) identificáveis na avaliação inicial das vítimas de trauma fechado. MÉTODOS: análise retrospectiva dos dados das vítimas de trauma fechado com idade superior a 13 anos submetidas à tomografia computadorizada do abdome e/ou laparotomia exploradora. Consideramos como graves as lesões com Abbreviated Injury Scale (AIS) maior ou igual a três. As variáveis foram comparadas entre os grupos A (LAG) e B (Sem LAG). Realizou-se inicialmente uma análise estatística univariada para identificar as variáveis associadas à presença de LAG. Destas, foram selecionadas para a análise multivariada (regressão logística) as que tivessem p 3 (Grupo A). Na análise univariada, associaram-se significativamente às LAG (p

OBJETIVO: Caracterizar os óbitos decorrentes de trauma em um hospital terciário e avaliar a qualidade do atendimento prestado a essas vítimas. MÉTODOS: Tratou-se de um estudo retrospectivo realizado em um centro de referência em trauma no período de um ano. Através da metodologia Trauma Score - Injury Severity Score e da revisão de prontuários foram identificadas e estudadas as mortes evitáveis, potencialmente evitáveis e inevitáveis. RESULTADOS: Setenta e cinco pacientes foram incluídos no estudo. Houve predomínio de mortes em pacientes jovens, do sexo masculino, vítimas de acidentes de trânsito. As médias do Revised Trauma Score, Injury Severity Score e Trauma Score - Injury Severity Score foram 5,60, 30,7 e 62,2%, respectivamente. A taxa de mortes consideradas evitáveis foi de 61,3%, potencialmente evitáveis, 24%, e inevitáveis, 14,7%. CONCLUSÃO: A amostra do estudo apresentou características epidemiológicas semelhantes às amostras de outros estudos, exceto pela alta taxa de mortes evitáveis e pelos altos valores do Revised Trauma Score. Houve dificuldades na obtenção de dados em prontuários, laudos de exames de imagem e laudos de necropsia. A qualidade do atendimento prestado às vítimas de trauma na Instituição se mostrou insatisfatória por problemas na coleta e armazenamento dos dados.

Objective: to identify the predictive variables or the massive transfusion triggers in severely traumatized patients through the existing scales., Method: a review of the literature was carried out using the Scoping Review method across the electronic databases CINAHL, MEDLINE, LILACS, the Cochrane and IBECS libraries, and the Google Scholar search tool., Results: in total, 578 articles were identified in the search and the 36 articles published in the last ten years were included, of which 29 were original articles and 7 review articles. From the analysis, scales for massive transfusion and their predictive triggers were examined., Conclusion: the absence of universal criteria regarding the massive transfusion triggers in traumatized patients has led to the development of different scales, and the studies on their validation are considered relevant for the studies about when to initiate this strategy.

Background: Trauma is the leading cause of death in young patients and thoracic trauma (TT) is responsible for 25-35% of trauma deaths., Aim: To describe and compare features, trauma severity indexes and morbidity of patients admitted for TT in the past three decades., Material and Methods: Review of a TT database, operative notes and medical records of patients. These were separated by decade of admission (1981-1990, 1991-2000, 2001-2010). TT characteristics were compared. Injury Severity Score (ISS), Revised Trauma Score (RTS-T) and Trauma Injury Severity Score (TRISS) were calculated., Results: A total of 3,068 TT were reviewed. In the 1981-1990 period, 604 cases of TT were registered (19.7%), in the 1991-2000 period, 1,070 cases (34.9%) and in the 2001-2010 period, 1,394 cases (45.4%) (p < 0.05). The ages of patients in each of these periods were 34.9 ± 15.5, 33.9 ± 16.2 and 35.7 ± 18.2 years respectively (p < 0.05). The proportion of patients aged 65 years or more were 6.6, 7.7 and 10.1% respectively, the proportion of females was 6.1, 9.4 and 12.0%, respectively. The causing agents per decade were knife wounds in 51.5, 61.1 and 60.0% of cases respectively, firearms in 2.5, 3.3 and 5.0% of cases respectively, multiple trauma in 13.9, 14.5 and 9.0% respectively and morbidity in 18.7, 19.7 and 11.7%, respectively. The ISS per decade was 11.9 ± 6.5, 12.9 ± 6.9 and 10.4 ± 6.8 respectively. No significant difference were found in mortality (1.5, 3.0, 2.0% respectively) or TRISS score (2.7, 3.2 and 3.8% respectively)., Conclusions: An increase in the number of hospital admission for TT has occurred in the last three decades, with an increase in the proportion of admissions of subjects aged 65 years or more, females and with firearm injuries.

Objectives: To explore differences in severity classifications according to 2 versions of the Abbreviated Injury Scale (AIS): version 2005 (the 2008 update) and the earlier version 98. To determine whether possible differences might have an impact on identifying severe trauma patients., Material and Methods: Descriptive study and cross-sectional analysis of a case series of patients admitted to two spanish hospitals with out-of-hospital injuries between February 2012 and February 2013. For each patient we calculated the Injury Severity Score (ISS), the New Injury Severity Score (NISS), and the AIS scores according to versions 98 and 2005., Results: The sample included 699 cases. The mean Severity (SD) age of patients was 52.7 (29.2) years, and 388 (55.5%) were males. Version 98 of the AIS correlated more strongly with both the ISS (2.6%) and the NISS (2.9%)., Conclusion: The 2008 update of the AIS (version 2005) classified fewer trauma patients than version 98 at the severity levels indicated by the ISS and NISS.